Provider Demographics
NPI:1083649867
Name:ROSENFELD, ALLAN GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:GREGORY
Last Name:ROSENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S WHEELING AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5649
Mailing Address - Country:US
Mailing Address - Phone:918-748-7854
Mailing Address - Fax:918-293-3116
Practice Address - Street 1:2000 S WHEELING AVE
Practice Address - Street 2:STE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5649
Practice Address - Country:US
Practice Address - Phone:918-748-7854
Practice Address - Fax:918-293-3116
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34144207T00000X
OK28951207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8973201Medicaid
BR2733168OtherDEA
215979Medicare ID - Type Unspecified
BR2733168OtherDEA